Situation tonight, was I wrong?

[reaper]

So you are in that mindset that we should flog every dead body we come across?

Sorry, again I work with real medicine and not fantasy that everyone is savable.

Why are you going to work an obviously dead trauma? You now have giving false hope to a family and stuck them with a huge ALS bill.

This falls under the same thing as show coding a pediatric pt, that is obviously dead. Just because they dont want to tell the family.

Trauma arrests are at 2%, because you can't fix dead!

 

[Medic38572]

So you are in that mindset that we should flog every dead body we come across?

Sorry, again I work with real medicine and not fantasy that everyone is savable.

Why are you going to work an obviously dead trauma? You now have giving false hope to a family and stuck them with a huge ALS bill.

This falls under the same thing as show coding a pediatric pt, that is obviously dead. Just because they don't want to tell the family.

Trauma arrests are at 2%, because you can't fix dead!

Reaper you still don't get what I'm talking about. I never said we should flog every dead body we come across. There are the exceptions to the rule.

Reaper why wouldn't you work a trauma code on an obvious dead person? You would work one a regular code? Is the pt not obviously dead? Whats the chances you'll get one back from Asystole? or PEA? I've done it? And they have walked out of the hospital.

I never give false hope to anyone. If they are dead I tell the family they are. I build no hope and give no promises. I do my job! What I was trained to do.
Ask the 2% if they cared about the huge ALS bill.

Being as most pediatric codes are respiratory in nature to begin with whats wrong with a little oxygen or an ET tube maybe a little suction to clear that airway, hey believe me with compressions the combination work's. Sure it may be useless depending on time. But what about those few we get back and straighten out!

Yea reaper I heard you again 2% trauma arrests survive. But those bilateral needle decompression's saved 2 of the ones I've worked who were not breathing and pulse-less!
Amazingly because I did my job they didn't become part of the 98% that don't survive.


Now just so this isn't misconstrued. What is an obvious dead or dead person to you?

 

[cumberlandcounty911]

better yet why dont we get into the topic of stopping while off duty, and since hes just out of school does he even have a license? which is another can of worms

 

[matty4522]

OP Here.

I do have a license, thats what I got 2 months ago. I have some interviews going next week with some EMS companies which is good.

Anyways, I found out the guys name, it was all over the news and such. No seatbelt, was possibly drinking. Its been about a week since this happened, I am not beating myself up over it. He was dead as dead could be. I wasn't going to roll up with my Galls ER/OR and my blow up Trauma surgeon and save the day. Stopping off duty? I only stopped because I saw blood and worried cop. I figured I could try to help. All in all, good learning experience I suppose.

 

[firetender]

all in all, good learning experience i suppose.

bingo!!!

 

[Aidey]

The only thing I'm trying to stress is that unless we make that effort, the truth will never be know except someone died and fell into that 98% range. I would much rather know that my sister, brother, mom or dad died after every effort or attempt was made to try and resuscitate them then to find out later that someone stood by who had all these credentials and didn't do anything other then pull them out of a car or other situation confirmed them in asystole in 3 leads and took them to the ED to be pronounced dead.

The following is my own opinion, but I do agree with everything Ven said.

Dead is dead, and we can only help the very recently dead. You HAVE to be able to discern a patient who may not stay dead from one who definitely will. We have a responsibility to determine if a pt is rescusitatable or not, and not just wantonly go all out on everyone.

It is all about assessment and seeing if the pt has signs of irreversible death. Eventually we all have to acknowledge that people die and sometimes there is nothing we can do, no matter how many credentials we have.

Generally EMS does not transport dead bodies. It's a good way to take an ambulance out of service until the corner can get there.

 

[Veneficus]

The patients you don't have

Generally EMS does not transport dead bodies. It's a good way to take an ambulance out of service until the corner can get there.

While this is most certainly accurate from the EMS standpoint, for perspective, consider the veiw of the entire healthcare system.

In addition to your ambulance, you can tie up an EM physician, A critical care surgeon, a couple of nurses or techs in the ED, a bed, and not only decrease the resources for the next emergent (as we would like to define it) patient but you bring many of the other patients already in the system to a halt. (possibly for hours)

THe EM working a fruitless code is not seeing other patients, emptying ED beds and creating a patient back up.

The Critical care surgeon is not in the ICU or surgery, depriving others of the knowledge and ability.

The grunt work of the ED is not being done by the nurses which holds up the system as much as missing a physician. More if like in most trauma centers I have seen 2 nurses respond to a life threatening trauma alert. (one to document, one to work bedside) Additionally a tech (aka paramedic) in the ED can also be tied up with the body.

What happens to the body takes resources, somebody has to tag it and bag it. Inventory belongings, deal with the distraught family. (sometimes even make the body available for viewing)

A bed/room is tied up until somebody from the morgue can come and pick up the body, which is not always instantaneous, especially in larger facilities or in hospitals that don't have an in house morgue staffed 24/7. You can't simply put the body in the hall.

Whether we all like it or not, admit it or not, or wish it was different, EMS has a direct effect on every patient in a given system. Including the ones they don't bring in on their individul truck. There is usually more than one EMS agency that uses the same hospital.

In some major hospitals in the US I am familiar with EMS contributes to between 10-15% of all patients admitted on a given day. That is not the total brought in. Most EDs are self reliant, you simply cannot float people into the department and expect them to function. I have seen it in major disasters and I can tell you the floaters often cause more troubles than they help. They don't have local access to meds, they don't know where equipment is, where/how to replace it, what protocols, treatments and procedures are available and when, or even how to find patients. They are not adept at triage, or handling multiple patients of varying levels of illness injury.

I admit I am the first to call BS on the propaganda of nursing, but I also realize what the actual abilities and contributions are. There is simply no substitute for an ED or ICU nurse in their respective environments. In any hospital and most healthcare facilities, if you overwhelm nursing, the whole place comes to a grinding halt. Taking one, much less 2 out of circulation in an ED for a corpse, is just unacceptable.

 

[Fox800]

Reaper you still don't get what I'm talking about. I never said we should flog every dead body we come across. There are the exceptions to the rule.

Reaper why wouldn't you work a trauma code on an obvious dead person? You would work one a regular code? Is the pt not obviously dead? Whats the chances you'll get one back from Asystole? or PEA? I've done it? And they have walked out of the hospital.

I never give false hope to anyone. If they are dead I tell the family they are. I build no hope and give no promises. I do my job! What I was trained to do.
Ask the 2% if they cared about the huge ALS bill.

Being as most pediatric codes are respiratory in nature to begin with whats wrong with a little oxygen or an ET tube maybe a little suction to clear that airway, hey believe me with compressions the combination work's. Sure it may be useless depending on time. But what about those few we get back and straighten out!

Yea reaper I heard you again 2% trauma arrests survive. But those bilateral needle decompression's saved 2 of the ones I've worked who were not breathing and pulse-less!
Amazingly because I did my job they didn't become part of the 98% that don't survive.


Now just so this isn't misconstrued. What is an obvious dead or dead person to you?

I don't even know where to begin with the amount of fail apparent in this post. It makes my head hurt trying to figure out what you're saying.

Dead is dead is dead. <1% survival rate. OK, now you're working a rolling code (I hope you're not working trauma arrests on scene instead of transporting...), you've taken an ALS ambulance, and probably an engine company out of service. You're doing ineffective CPR in a moving vehicle. No one is buckled in. You are putting everyone in the ambulance and others on the road at risk of collision. For what?

Pronouncing trauma arrests in the field is not "skipping out on your job". It's being realistic and making an educated decision that allows the EMS, first response, and hospital resources to remain free for those that can be treated.

And I'm pretty sure on the pediatric arrests we were talking about OBVIOUSLY dead patients (dependent lividity, rigor mortis). NO ONE is suggesting that you "call" someone's child who is viable.

 

[Hal9000]

Pronouncing trauma arrests in the field is not "skipping out on your job". It's being realistic and making an educated decision that allows the EMS, first response, and hospital resources to remain free for those that can be treated.

And I'm pretty sure on the pediatric arrests we were talking about OBVIOUSLY dead patients (dependent lividity, rigor mortis). NO ONE is suggesting that you "call" someone's child who is viable.

On an interesting sidenote (one that I tend to forget once I go home for the day), I once saw an ambulance bring in a traumatic arrest from down the street. While circulation was restored, the anesthesiologist looked at the mediastinum and told everyone that we were going to cease care, because the damage was simply too great. In his words, "Save the blood for someone that will at last the day. There's no way we can fix all her problems."

Sometimes that's just the truth.

 

[Mountain Res-Q]

On an interesting sidenote (one that I tend to forget once I go home for the day), I once saw an ambulance bring in a traumatic arrest from down the street. While circulation was restored, the anesthesiologist looked at the mediastinum and told everyone that we were going to cease care, because the damage was simply too great. In his words, "Save the blood for someone that will at last the day. There's no way we can fix all her problems."

Sometimes that's just the truth.

My opinion ona all this remains the same for the reasons stated; trauma codes should not be worked unless there are special circumstances where you decide (based on medical education and a legit stance you can justify) that we have a real shot of saving this person. I am reminded of a line from one of my favorite movies of the last 5 years; The Guardian:

"Save the ones you can Jake. The rest, you've got to let go."

 

[ShannahQuilts]

Was I wrong? This was my first "Code" but I felt like we should have tried.

It's easy for everyone to armchair quarterback. I'm sure that most of the responses are "correct".

However, I will say, if it was my husband in that car, and you were not sure if he could be revived, I'd be forever grateful to you for trying, whether or not you were successful.

 

[Cohn]

I'm wondering about the legal side of working/not working an arrest in this case.
If in his locale OP is not under his medical command when off duty, would it be considered an abandonment if he made pt. contact, checked for LOC and pulse, and then decided not to do CPR?

Good Samaritan law...

He was not on duty.

 

[Medic38572]

Good Samaritan law...

He was not on duty.

Question:
If you are not on duty and you stop to render aid. And you render none, how can you claim good Samaritan law. You should never have stopped to begin with! But now that you have stopped you have committed yourself by laying hands on a pt.

 

[Medic38572]

it's easy for everyone to armchair quarterback. I'm sure that most of the responses are "correct".

However, i will say, if it was my husband in that car, and you were not sure if he could be revived, i'd be forever grateful to you for trying, whether or not you were successful.

bingo!!!!

 

[reaper]

Question:
If you are not on duty and you stop to render aid. And you render none, how can you claim good Samaritan law. You should never have stopped to begin with! But now that you have stopped you have committed yourself by laying hands on a pt.

Stopping does not commit to doing anything. You stop, you check, your determine viability. That is about real medicine.

 

[Sasha]

Ask the 2% if they cared about the huge ALS bill.

Do you realize that even if they have health insurance that huge bill, patient survived or not, can ruin families financially which often tear the family apart?

But those bilateral needle decompression's saved 2 of the ones I've worked who were not breathing and pulse-less!

How long did they survive? What was their life like after? Neuro function intact, or self watering vegetable?

Calling codes in the field before resuscitation efforts is becoming more common. It's reality. It's a waste of resources and money if they truly are dead, man up, tell the family you're sorry, there is nothing you can do, and move on.

 

[usafmedic45]

If you are not on duty and you stop to render aid. And you render none, how can you claim good Samaritan law. You should never have stopped to begin with! But now that you have stopped you have committed yourself by laying hands on a pt.

As was said before, you're not legally bound to do anything (not even required to stop in most places) and even if you choose to do "something" and get "involved", you are not required to anything beyond what is medically justifiable. Determining non-viability and stepping away is doing something. In fact, in this case, doing anything at all after you find that the patient is- as a point of fact- quite dead, doing any sort of effort on this case is going to put you at greater legal risk than doing what you regard to be "nothing".

However, i will say, if it was my husband in that car, and you were not sure if he could be revived, i'd be forever grateful to you for trying, whether or not you were successful.

If it were my fiancee, I'd be rather ticked off that someone went all Ricky Rescue on her remains. To each and to their own...personally I follow something that I saw printed in an ACLS study guide many years ago: "Prevent when possible, treat effectively when challenged and when all else fails support humanely".